Steinemann Susan, Bhatt Ajay, Suares Gregory, Wei Alexander, Ho Nina, Kurosawa Gene, Lim Eunjung, Berg Benjamin
From The Queen's Medical Center (S.S., A.B., G.S.); Department of Surgery (S.S.), Division of Emergency Medicine (A.B., G.S.), Biostatistics and Quantitative Health Sciences (E.L.), SimTiki Simulation Center (B.B.), University of Hawaii, John A. Burns School of Medicine (A.W., N.H., G.K.).
J Trauma Acute Care Surg. 2016 Jul;81(1):184-9. doi: 10.1097/TA.0000000000001024.
Briefing of the trauma team before patient arrival is unstructured in many centers. We surveyed trauma teams regarding agreement on patient care priorities and evaluated the impact of a structured, physician-led briefing on concordance during simulated resuscitations.
Trauma nurses at our Level II center were surveyed, and they participated in four resuscitation scenarios, randomized to "briefed" or "nonbriefed." For nonbriefed scenarios, nurses independently reviewed triage sheets with written information. Briefed scenarios had a structured 4-minute physician-led briefing reviewing triage sheets identical to nonbriefed scenarios. Teams included three to four nurses (subjects) and two to four confederates (physicians, respiratory therapists). Each team served as their own control group. Confederates were blinded to nurses' briefed or nonbriefed status. Immediately before, and at the midpoint of each scenario, nurses estimated patients' morbidity and mortality and ranked the top 3 of 16 designated immediate care priorities. Briefed and nonbriefed groups' responses were compared for (1) agreement using intraclass correlation coefficient, (2) concordance with physicians' responses using the Fisher exact test, (3) teamwork via T-NOTECHS ratings by nurses and physicians using t-test, and (4) time to complete clinical tasks using t test.
Thirty-eight nurses participated. Ninety-seven percent "agreed/strongly agreed" briefing is important, but only 46% agreed briefing was done well. Comparing briefed versus nonbriefed scenarios, nurses' estimation of morbidity and mortality in the briefed scenarios showed significantly greater agreement with each other and with physicians' answers (p < 0.01). Rank lists also better agreed with each other (intraclass correlation coefficient, 0.64 vs 0.59) and with physicians' answers in the briefed scenarios. T-NOTECHS Leadership ratings were significantly higher in the briefed scenarios (3.70 vs 3.39; p < 0.01). Time to completion of key clinical tasks was significantly faster for one of the briefed scenarios.
Discordant perceptions of patient care goals was frequently observed. Structured physician-led briefing seemed to improve interprofessional team concordance, leadership, and task completion in simulated trauma resuscitations.
在许多中心，患者到达前对创伤团队的情况介绍是无组织的。我们就患者护理优先事项的共识对创伤团队进行了调查，并评估了在模拟复苏期间由医生主导的结构化情况介绍对一致性的影响。
对我们二级中心的创伤护士进行了调查，他们参与了四个复苏场景，随机分为“接受情况介绍”组或“未接受情况介绍”组。对于未接受情况介绍的场景，护士独立查看带有书面信息的分诊单。接受情况介绍的场景有一个由医生主导的4分钟结构化情况介绍，回顾与未接受情况介绍场景相同的分诊单。团队包括三到四名护士（受试者）和两到四名协同者（医生、呼吸治疗师）。每个团队作为自己的对照组。协同者对护士是否接受情况介绍不知情。在每个场景之前和中间点，护士估计患者的发病率和死亡率，并对16项指定的即时护理优先事项中的前3项进行排序。比较接受情况介绍组和未接受情况介绍组在以下方面的反应：（1）使用组内相关系数的一致性，（2）使用Fisher精确检验与医生反应的一致性，（3）通过护士和医生使用t检验的T-NOTECHS评分评估团队合作，以及（4）使用t检验完成临床任务的时间。
38名护士参与。97%的人“同意/强烈同意”情况介绍很重要，但只有46%的人认为情况介绍做得很好。比较接受情况介绍与未接受情况介绍的场景，接受情况介绍场景中的护士对发病率和死亡率的估计显示，彼此之间以及与医生的答案之间的一致性显著更高（p<0.01）。排名列表彼此之间以及与接受情况介绍场景中医生的答案也更一致（组内相关系数，0.64对0.59）。接受情况介绍场景中的T-NOTECHS领导能力评分显著更高（3.70对3.39；p<0.01）。在一个接受情况介绍的场景中，完成关键临床任务的时间明显更快。
经常观察到对患者护理目标的不一致看法。在模拟创伤复苏中，由医生主导的结构化情况介绍似乎提高了跨专业团队的一致性、领导能力和任务完成情况。
